What is arthritis?
Arthritis is the medical term for damage to a joint. This can range from a minor loss of cartilage to a completely worn out joint. It is an extremely common condition affecting many adults in the UK. As the population ages, more people will struggle with this debilitating condition. On an x-ray it appears that the spaces between the bones are reduced. In reality this is due to the loss of cartilage which does not show up on an x-ray.
How have I developed arthritis?
Osteoarthritis is the most common type of arthritis, where there is gradual wear and tear of a joint. The cause for this condition is often unknown. Sometimes if the joint has been previously injured (post traumatic arthritis) this can accelerate the wear and tear. If a fracture of the bone has extended into the joint this will have damaged the smooth cartilage lining. Any residual step remaining on the joint surface will cause the joint to wear out more quickly.
Rheumatoid arthritis is the most common inflammatory arthritis. This is where the patient’s own immune system attacks the lining of the joint (the synovium). Patients with an inflammatory arthritis often notice their joints are stiff and ache in the morning but are better late in the day. Inflammatory arthritis can severely damage joints but it can be well controlled with modern anti-inflammatory medication.
Arthritis eventually wears away the smooth cartilage covering the surface of the joint and the bone underneath becomes damaged. This causes joint pain and stiffness, which can interfere with normal activities.
How is arthritis treated?
Initially your GP will manage arthritis with non- surgical methods. This is always sensible as operations carry an inherent risk. These are likely to be:
Paracetamol is a very effective pain killer for arthritis and has very few side effects. It should be used under instruction from your GP but I usually recommend it be taken regularly, at full dose.
Anti-inflammatories (Ibuprofen, Naproxen) act in a different way to Paracetamol. They reduce inflammation (redness, pain, swelling etc) in the joint. It can have side effects and should only be taken after consultation with your GP. These can be stomach pain/bleeding, worsening of asthma and kidney failure.
Supplements to your diet, such as cod liver oil or Glucosamine, may also help relieve your symptoms. You should check with your doctor before you take supplements.
Using a walking stick can make walking easier. It should be held in opposite hand to the affected hip but on the same side as a painful knee.
Physiotherapy and regular moderate exercise can help to reduce stiffness and strengthen weak muscles. It also helps if a patient is due to have a joint replacement. Patients with strong supple joints find the post op physiotherapy easier and recover more quickly.
A steroid injection into your joint can sometimes reduce pain and stiffness for several months, particularly for inflammatory arthritis. Steroid injections are not usually given more than two or three times a year. Artificial Hyaluronic acid can also be injected and replaces some of the body’s natural joint fluid.
What are the surgical treatments for arthritis?
An arthroscopy (keyhole surgery) can be used to clean out an arthritic knee. It is also useful to remove any loose bone or cartilage fragments that have formed. This is a lower risk operation than a knee replacement. Unfortunately, arthroscopy becomes less effective as arthritis gets worse and it may be that a joint replacement is the best option. If an x-ray of the hip or knee shows “bone on bone arthritis” then only a joint replacement will cure the problem.
Will the arthritis get worse if I don't have surgery?
Once the cartilage lining of a joint is badly damaged it cannot recover. Typically the disease does worsen with time but it may never become bad enough to warrant a joint replacement. Also if patients reduce their activity levels significantly they may find the pain from the joint improves.
What does the operation involve?
Patients will be admitted to hospital on the day of surgery. I usually recommend patients have a spinal anaesthetic but this should be discussed with the anaesthetist. The operation usually takes between an hour and an hour and a half although patients are away from the ward for about two to three hours in total.
There are many different types of knee replacement available but I recommend the Corail / Pinnacle Total Hip Replacement and the Attune Total Knee Replacement. Both have excellent long-term results and give a superb functional outcome.
An incision in the middle of the knee or the side of the hip is performed and the arthritic surfaces are removed. These are then replaced with an artificial joint made of metal, plastic, ceramic, or a combination of these materials.
The knee replacement is fixed to the bone using Methyl Methacrylate cement. The hip replacement has a special Hydroxyapatite coating that bonds directly to the skeleton. At the end of the operation, the skin is closed with clips.
Am I fit enough to have the operation?
This is dealt with at the pre-operative clinic. This is routine before all surgery. A health screen is performed and blood tests taken. Patients are also advised on which medications can be continued and which should be stopped before surgery. Blood thinning medicines (Warfarin, Clopidogrel etc.) should be stopped before surgery to prevent excess bleeding. We may refer you to see an anaesthetic doctor if necessary.
Should I exercise before the operation?
Yes, although it may be difficult with a painful joint. Regular exercise will improve the heart and lungs but will also aid recovery from a joint replacement. Particularly after a knee replacement, patients have to work hard with the physiotherapists to gain movement in the knee. This is easier if the joint is strong and supple to begin with.
What are the risks of surgery?
When will I go home after a joint replacement?
I pride myself in running an enhanced recovery practice. With my colleagues at Warwick Hospital we run one of the best performing joint replacement units in the country (Intelligence, 2011). Typically patients will be up and out of bed on the first day after surgery. This is the best way to reduce the complications of blood clots, chest infections and pressure sores. Most patients will go home on approximately day three or four after surgery. The clips in the skin are removed approximately 10 to 14 days after surgery and the patient is then reviewed in clinic at six weeks.
Intelligence, D. F. (2011). Inside your hospital: Dr Foster Hospital Guide 2001-2011. London: Dr Foster Limited.